Cervical Spine Trauma 03 - Clinical Case Summary
Cervical Spine Trauma 03 - Clinical Case Summary
Cervical Spine Trauma 03 - Clinical Case Summary
SummaryHistory
19 yo male unrestrained driver, auto hit a tree
Exams Performed
Cervical spine plain film; Cervical spine CT; Cervical spine MR
Prior available imaging reports
Plain film cervical radiograph
1. There is a type-2 dens fracture.
2. There is (likely) a unilateral articular pillar fracture accounting for the significant rotary subluxation and 2 mms of anterolisthesis at C4-5.
3. There is a transverse posterior C1 ring fracture.
Cervical CT
1. There are three fractures involving the cervical spine. Two fractures are evident in the upper cervical spine. There is a C1 ring fracture without appreciable fracture offset nor diastasis. There is a type-2 dens fracture with minimal anterolisthesis not affecting the spinal canal to any significant extent. There's also evidence of facet capsular strain with increased synovial fluid in the condylar-C1, and the C1-C2 joint spaces bilaterally.
2. The third fracture is a compression fracture involving the mid-body portion of the right C4 articular pillar. This fracture complex has resulted in an abnormal rotation at the C4-5 level. There is also a right sided widening of the C4-5 uncovertebral joint space.there is a 2 mm C4-5anterolistesis; the spinal canal width is not affected. This may represent a secondary effect of the abnormal C4-5 motion segment rotation, or could represent an actual rotational injury affecting the uncovertebral joint. This could be resolved on MR, however, it is likely a minor injury at best and would not likely contribute to any spinal instability.
3. The combination of a C1 ring fracture and the type-2 dens fracture plus the upper cervical facet joint strain make the upper cervical region likely unstable. The rotary injury at C4-5 related to the articular process fracture and the potential uncovertebral strain are potentially but not definitely unstable.
Cervical spine MR
1. Multilevel spinal injuries including: 1. joint capsular strain with joint effusions at both the condylar-C1 and the C1-2 joint spaces bilaterally; 2. nondisplaced C1-ring fractures; 3. Type-2 dens fracture with 2 mm of anterolisthesis, which does not cause appreciable spinal canal stenosis; 4. right articular body fracture resulting in approximately 15 degress of abnormal spinal rotation at he C4-5 level; 5. right C3-4 articular facet joint post traumatic joint effusion; 6. C4-5 minimal uncovertebral joint injury.
1. There is a type-2 dens fracture.
2. There is (likely) a unilateral articular pillar fracture accounting for the significant rotary subluxation and 2 mms of anterolisthesis at C4-5.
3. There is a transverse posterior C1 ring fracture.
Cervical CT
1. There are three fractures involving the cervical spine. Two fractures are evident in the upper cervical spine. There is a C1 ring fracture without appreciable fracture offset nor diastasis. There is a type-2 dens fracture with minimal anterolisthesis not affecting the spinal canal to any significant extent. There's also evidence of facet capsular strain with increased synovial fluid in the condylar-C1, and the C1-C2 joint spaces bilaterally.
2. The third fracture is a compression fracture involving the mid-body portion of the right C4 articular pillar. This fracture complex has resulted in an abnormal rotation at the C4-5 level. There is also a right sided widening of the C4-5 uncovertebral joint space.there is a 2 mm C4-5anterolistesis; the spinal canal width is not affected. This may represent a secondary effect of the abnormal C4-5 motion segment rotation, or could represent an actual rotational injury affecting the uncovertebral joint. This could be resolved on MR, however, it is likely a minor injury at best and would not likely contribute to any spinal instability.
3. The combination of a C1 ring fracture and the type-2 dens fracture plus the upper cervical facet joint strain make the upper cervical region likely unstable. The rotary injury at C4-5 related to the articular process fracture and the potential uncovertebral strain are potentially but not definitely unstable.
Cervical spine MR
1. Multilevel spinal injuries including: 1. joint capsular strain with joint effusions at both the condylar-C1 and the C1-2 joint spaces bilaterally; 2. nondisplaced C1-ring fractures; 3. Type-2 dens fracture with 2 mm of anterolisthesis, which does not cause appreciable spinal canal stenosis; 4. right articular body fracture resulting in approximately 15 degress of abnormal spinal rotation at he C4-5 level; 5. right C3-4 articular facet joint post traumatic joint effusion; 6. C4-5 minimal uncovertebral joint injury.
Lessons to be Learned
1. This case demonstrates the far reaching effects of a rotary fracture mechanism.
2. This case also demonstrates how multiple mechanisms are often at play in any significant cervical trauma. In this case the C1 ring fractures and the upper cervical synovial joint effusion are axial-loading injuries, while the articular pillar and oblique dens fractures are likely rotary in nature.
3. This case also demonstrates how MR contributes to delineation of synovial joint injuries.
2. This case also demonstrates how multiple mechanisms are often at play in any significant cervical trauma. In this case the C1 ring fractures and the upper cervical synovial joint effusion are axial-loading injuries, while the articular pillar and oblique dens fractures are likely rotary in nature.
3. This case also demonstrates how MR contributes to delineation of synovial joint injuries.